Sunday, January 07, 2007

The entrenchment of MRSA
Jan. 5, 2007

More than 1,000 people in our region will catch a terrible infection this year that no antibiotic will easily defeat. The worst cases will be fatal, but even the ones that aren’t will still be dangerous, unpleasant and extremely difficult to clear up.
Once upon a time, an infection like the one taking root right now was a problem only for very specific populations. A few isolated tribes of Australian aborigines. People living on the streets. Athletes playing contact sports. Military recruits.
Not anymore. The staph infections showing up in our community lately are occurring in people with no known risk factors. “We are the epicentre of the country,” local infection specialist Dr. Pamela Kibsey said this week.
Human beings have been grappling with staphylococcus infections for millennia, of course. No small wonder penicillin was given a hero’s welcome upon its invention in the 1940s, considering how many people had been killed by infection up to that point.
Alas, you can’t keep a bad bug down. From the emergence of penicillin-resistant staph barely a decade after penicillin’s discovery, to the multi-resistant “superbugs” of today, we have yet to vanquish a very old foe.
Bacteria are clever beasts, and likely would have given us a run for our money no matter what strategy we took for surviving their onslaughts. Staph bacteria have reached the point of being able to mutate almost as fast as the latest wonder drug is being rushed to market.
But we’ve also aided the bugs’ cause immensely by doing just about everything wrong in terms of infection control. It starts with years of gulping antibiotics like candy and continues through a long series of health-care and social policy changes made for reasons of economy rather than disease management.
And now we’ve all got a problem.
The latest version of staph has a big name: Community-acquired Methicillin Resistant Staphylococcus Aureus. The experts call it CA-MRSA.
In this region, we’ve been living with HA-MRSA - the kind you get in hospital - for almost a decade. What’s going on now is basically the result of the same bug, except you don’t have to go to the hospital anymore to end up infected.
My dad had the dubious honour in the late 1990s of being one of the first hospital patients in the region to acquire MRSA. The bacteria got into a surgical wound. The ensuing infection almost killed him, and the heavy-duty antibiotics he had to be on took almost as serious a toll.
More pertinently to those beyond his immediate family, he cost the system a fortune. He was in isolation in hospital for five months, on an antibiotic drip that cost more than $150 a day.
The intensity of his illness definitely would have pushed up his nursing costs. And every day he was in hospital meant another day of risk for everyone else who was in there, because staphylococcus aureas spreads like crazy among the sick and weak.
Add eight years of inflation and the spiralling costs of pharmaceuticals, and you can figure out how much this same scenario would cost today. If my dad had been in his working years and not yet retired, the financial hit he’d have taken from being laid up for five months would have been disastrous on a whole other level for my family.
Not all of the 1,000 cases of MRSA in the coming year will be as dramatic, of course. Staph presents differently in everybody, from relatively minor boils to ravaged lungs. A few of us live with MRSA in our bodies all the time, and never get sick.
Still, the entrenchment of MRSA over time is the alarming part. I used to think the trick was to stay away from antibiotics and hospitals, but now it seems that even those ramparts have been breached. The world is growing ill enough that individual efforts to stay healthy are no longer a guarantee.
Why the rise in infection? Pick your theory. We now have ghettos of street people being left to sicken in our downtowns. We’ve seen huge changes in health care. Our food supply is downright alarming, saturated in antibiotics.
Start with an increasingly privatized and mobile health-care force that travels from site to site, inadvertently spreading infection. Mix in ever-shorter hospital stays, heightening the risk that someone is released into the community before their brewing infection is even noticed. Then there’s the overcrowded emergency rooms, stacked with those sickly victims of the street and everybody jammed together for hours.
We eat meat and eggs from antibiotic-laden animals, the poor sods would not survive the miserable conditions of factory farming without the drugs. We overuse antibiotics ourselves, continuing to take them for the wrong things, at the wrong time, in the wrong way.
It doesn’t have to be this way. But for as long as it is, brace yourself for the consequences.

Sunday, December 31, 2006

Safe travels in Mexico
Dec. 29, 2006

For the most part, I try not to crab about the opinions of other writers in these pages. It just doesn’t seem professional.
But George Jonas’s scare piece last week on Mexico and Cuba was just too ridiculous to let slide. He contends he’s travelled a lot, but his comments read like somebody who never leaves home.
The point of the piece was to lament those puzzling Canadians who continue to like holidaying in sunny destinations that Jonas has chosen to categorize as “impoverished and lawless countries.”
He chastised such travellers for being tempted by cheap holidays when what they ought to be thinking about were the tremendous risks they were taking by visiting such places. “Get your tan in Arizona this year,” opined the Toronto writer.
His remarks would have rubbed me the wrong way regardless of the countries he singled out, given that I’ve travelled enough to see that it’s never that simplistic. But his selection of Mexico got under my skin even more. I’m very fond of the place and would count myself lucky to be living there.
Jonas points to the murders of Toronto couple Dominic and Nancy Ianiero earlier this year as examples of why any sane tourist ought to reconsider ever travelling to Mexico. Why, those Mexicans will slash your throat in a heartbeat, as happened to the couple on the eve of their daughter’s wedding at a high-end beach resort a couple hours south of Cancun.
I feel for the Ianiero family. But there’s nothing particularly Mexican about 11 months having passed and no murderer being caught. The same thing happens somewhere in Canada pretty much on a weekly basis. That’s the case in the U.S. as well, despite Jonas’s apparent belief that all is right in Arizona.
Nor was what happened to the Ianieros even remotely a typical thing to happen to a tourist in Mexico. Tens of thousands of world travellers pass unharrassed through Mexico every year. Even now, they continue to sleep in comfort and security in the five-star beds of the very resort where the Ianieros were killed, and equally safely in the one-star hotels and hostels of less prosperous neighbourhoods all over the country.
Travelling in a country with a dramatically different standard of living does require a certain amount of awareness. There are areas in every Mexican town where I wouldn’t walk with diamonds around my neck and a big fat purse dangling loose from my shoulder, but that holds true for parts of Vancouver, Toronto and Prince George as well. No need to tempt fate.
But there’s no evidence so far that what happened to the Ianieros has anything to do with that.
To date, no one has produced an impoverished and lawless Mexican who plotted the Ianiero murders. In fact, nothing was identified as even being stolen from the couple’s room. No motive has been advanced for their deaths, least of all one that conveniently turns it into a story of naive holidayers and evil Mexicans.
Far from accepting the Ianiero murders as cautionary tales for Canadian travellers who choose cheap sun holidays, we should see them as the tragic and isolated events that they were. What happened to the couple was horrible, but it’s got nothing to do with an overall risk to tourists.
We stayed not far from the Barcelo resort in the weeks immediately after the Ianiero murders, and were stopped in our tracks more than once at a news stand by graphic photos of the murder scene that ran in some of the Mexican papers.
The couple looked like they had been executed. Each bore the marks of a quick and brutal single cut to the throat. They were left for dead where they dropped.
Whatever the eventual explanation for such brutality, I’m willing to bet that it won’t have anything to do with Canadian tourists randomly singled out by impoverished and lawless Mexicans.
For one thing, the chance that such a Mexican could slip through the extensive security system that surrounds five-star resorts like the Barcelo is extremely unlikely.
Knowing how important it is for visitors to feel safe in Mexico, the country guards its high-end tourist resorts with hard-bitten security types, big iron gates, and real guns. If you were a typical Mexican looking to slip by the watchman at the Barcelo to kill a couple Canadians for no apparent reason, you’d really have to work at it.
For another, that’s just not how life unfolds in Mexico. Sure, you could be attacked while travelling there. But thankfully, you almost certainly won’t be.
The same can be said for Vancouver, where a young Korean visitor was beaten into a near-vegetative state four years ago. No warnings went out to tourists cautioning them to stay away from that city for fear of similar treatment. The attack on Ji Won Park was correctly interpreted as the awful and rare event that it was.
Bad things can happen anywhere, including Mexico. But mostly, they don’t.

Sunday, December 24, 2006

The upside of aging
Dec. 22, 2006

There’s no avoiding the gravitus of a birthday ending in zero. I’ve just marked a big one, 50, but they’ve all been notable in their own way.
When I turned 20, I felt the weight of no longer being a kid anymore. Like it or not, life was underway. At 30 - the only really tough one for me - I had to give up on a dearly held belief that I’d have everything sorted out by the time I was 30.
Then came 40, and I was OK with it. I’d won and lost on a number of big life fronts by then, but was ultimately happy with where the fates had carried me. Ten years on, the feeling of personal peace is that much stronger, and I find myself grateful for the gifts of aging.
I’ve been a restless soul for most of my life, always knowing I was looking for something but never too sure what it was. But somewhere in the last decade, I think I must have found it.
It didn’t arrive with fury and splendour, and was more like a gradual unfolding. People’s opinions of me no longer mattered as much. I gave up wanting to be the belle of the ball. I settled down. Something like contentment occasionally settled over me.
A psychology type like Maslow would no doubt say that I was finally getting my needs met. Sure, but first you have to stick it out long enough just to be able to identify them. For the longest time, my needs rattled around namelessly inside me, wreaking havoc with the various life plans I tested over the years.
To let go of all that unfocused striving and yearning has been the wonder of aging. Nothing wrong with a little striving and yearning, of course, but nothing wrong with being done with it, either.
I suppose it’s about being on the other side of all of life’s big milestones. Marriage. Children. Careers. Houses. Great loves. You spend your first 40 years trying to make all of that happen, and it isn’t until 50 that you finally get the opportunity to just enjoy what you have.
Time also assumes greater meaning as you age, as it ought to when you consider how each day that passes accounts for a larger percentage of the life you have left to live. Two days lost to unpleasantness at age 20 is a much more significant loss at age 50, when every day counts that much more.
Perhaps that’s the most important lesson of aging: That life slips away faster and faster. I find myself grabbing the days with calculated enthusiasm. I’ve miles to go before I sleep, as the saying goes, and a single wasted hour now seems a shame.
I’ve even worked out the number of weekends I can expect to enjoy if I’m lucky enough to live to 75 or 80. Once, when I narrowed the category to “summer weekends,” I was devastated by how few remained. It wasn’t a pleasant exercise, but it certainly got my attention. No weekend slips by me unawares anymore.
Because I’m no longer consumed with the chase like I was in my younger years, I have more energy for new interests. In recent months, it’s been kayaking and Taiko drumming, even a few pole-dancing classes. The self-consciousness that would have stopped me in my tracks as a younger woman has been vanquished by the passing years. And how truly wonderful to have it gone.
Lately, I’ve developed a near-obsessive interest in birds, something my youngest daughter says seems to be a trend among people my age. If that’s true, perhaps it stems from a need to revel in what’s good about the world, right there outside our windows.
I watch my own adult children struggling, and find myself advising them to hang in there until things can get better in their 40s. The worst of it is that you’re convinced for all those years that it’s only you that can’t figure things out. It must be far more intense for today’s young adults than it was when I was younger, what with ever-rising expectations on each coming generation to run faster, jump higher, try harder and earn a lot more money.
I can’t say that I ever relished the thought of turning 50 during the years of rushing forward into my future. But now that it’s here, I see that it comes in peace. The loss of tight jawline and taut midriff aside, I can tell that 50 wants the best for me.
This past weekend, with the December sun slanting across the waters of Portage Inlet, I kayaked in great happiness past rafts of wintering ducks, snatching up my damp binoculars at regular intervals to categorize the distant specks into bufflehead, golden eye, hooded merganser. An unfamiliar feeling took hold: Serenity.
Peace in my time. If that’s what it means to grow old, bring it on.

Saturday, December 16, 2006

Sex workers owed decent workplaces
Dec. 15, 2006

In its own small way, the police raid on 18 Greater Vancouver massage parlours last week has a bit of the “weapons of mass destruction” scam about it.
Like the invasion of Iraq, the raids were staged under what would turn out to be false pretenses. Raiding a business is, after all, fairly serious stuff in a democratic country. The justification in this case was that the businesses in question were involved in human trafficking, possibly brought into Canada against their will. The raids would in fact be helping people escape a desperate situation.
“Previous experience dealing with human trafficking on a global level has shown the victims of human trafficking are often found working in establishments such as the ones searched last night,” RCMP Supt. Bill Ard said confidently the day after the Dec. 8 raids.
Could be. But not this time. None of the 78 women found at the massage parlours were illegal immigrants. None were younger than 21, nor did any want a transition bed when one was offered to them after the raid.
The raids were pitched as a means of reaching out to enslaved women forced into the sex trade against their will. Instead, those same women ended up accounting for the majority of people arrested in the raids. A week later, charges have yet to be laid against anyone.
What that means in terms of government spending is that some 200 police officers were involved for months in plotting a big raid on 18 B.C. massage parlours, which ultimately turned out to be nothing more than yet more hassle for a group of workers who were theoretically the “victims” when the raids started taking shape.
What that means in terms of adherence to democratic principles is that raids on 18 legitimate businesses were carried out under false pretenses. The raids were sold as rescues, but nobody was looking to be saved.
Solicitor General John Les depicted the raids this week as a “huge shot across the bow” for anyone considering getting into the prostitution business. Oh, please. The sex industry will barely register a blip from the raids. The only ones who will feel the pain are the women who work in the sex trade, who will once again go looking for even darker corners to escape the scrutiny of police.
How can we continue to be surprised at the presence of a sex trade in our cities? As long as there are men who want to buy sex, there will be women and men who will sell it. That’s how it’s been in our community since the first non-aboriginal settlements took root, and in every other community around the world for as long as human history. Surely we can’t still think that this is a matter for the police.
Misguided police raids in Vancouver back in the 1970s were a significant factor in the spike in street prostitution in the years after that. Up until then, B.C.’s sex trade had mostly been an indoor industry, operating in places like Vancouver’s old Penthouse Cabaret. After the busts, sex workers were displaced to the Downtown Eastside. A frightening rise in assaults, rapes and murders involving those workers soon followed.
Three decades later, we’re apparently as baffled as ever about what to do about prostitution beyond more of the same. And no small wonder. We’re clearly stuck if we still believe that complex, costly police raids dressed up like rescues are how we’ll “crack down” on the sex industry.
Not only are such raids a disturbing waste of money, the people who bear the brunt of the impact are typically the very workers identified as needing to be saved through police intervention. All that the latest raids have done for the women rounded up at the 18 massage parlours in Coquitlam, Surrey, Richmond, Burnaby and Vancouver is to push the workers into even more invisible places in the future to avoid hassles with police. Some may even end up working the streets, which are as dangerous as ever to those forced to do their business there.
What’s to be done? It starts with coming to grips with the sex trade, and the fact that it exists no matter how much we wish it didn’t. We’ve all got our views on the morality of the trade, but there comes a point when continuing to do nothing is the most immoral act of all.
The ugly aspects of the sex trade most definitely have to be routed. Exploitation of a child, sexual slavery, coercion -all must be vigorously pursued and punished. But at the same time, we desperately need to address working conditions for the thousands of Canadian adults who continue to work in the sex industry. In an age when even lumber is bought ethically, we at least owe that small courtesy to those who sell sex.
Sex sells, and the buyers are us. All the pointless police raids in the world can’t change that.

Saturday, December 09, 2006

A recipe for creating homelessness
Dec. 7, 2006


I don’t think the word “homelessness” was something that our communities ever thought of up until a few years ago. Sure, there were always a few homeless people. But nobody foresaw a time when homelessness would become more or less of a permanent condition for thousands of British Columbians.
Signs of it sneaking up on us were evident in Times-Colonist stories of the early 1990s if we’d paid more attention. First came the warnings from the front lines that more and more people were struggling. Then the business community brought its concerns to the table, starting in 1996 when then-mayor Bob Cross and his council took a hard line against “aggressive” panhandlers.
And here we are 10 years on. Entire homeless families now alternate between cheap motels in the winter and campsites in the summer, and at least twice as many broken people with nowhere else to go now live on downtown streets. For kids growing up on the edges of homelessness, it means constantly changing schools, losing contact with friends, and living a heartbeat away from imminent disaster. That’s a very hard way to grow up into a happy, healthy adult.
How did we end up here?
It started with short-term, political social-policy decisions made with nary a thought to the tremendous long-term impacts. In the 1980s, we opened the doors of our giant institutions, and we pushed thousands of people with mental illnesses and developmental disabilities out into the community. We promised community support and failed to deliver. Then we decimated welfare spending and quit building social housing.
More significant than those missteps, however, is the fact that we’ve done virtually nothing to rectify them. The problems have worsened before our very eyes, and we have carried on as if blind to the increasingly visible signs of damage in our communities. We appear to have convinced ourselves that the social problems we’re grappling with have nothing to do with years of massive and poorly thought-out cuts to social services.
In fact, we often talk about homelessness these days not as evidence of our mistakes, but as something that just might be inevitable - part of the growing pains of becoming a city. As if the only choice we have around homelessness is to learn to live with it.
To walk the downtown at any time of the day or night is to see the results of all that non-strategy and neglect.
On the left, a long string of impossibly overloaded shopping carts parked precariously along the sidewalk near Streetlink. Up the street, countless downtown doorways and cubbyholes put to use as makeshift winter campsites. Across the bridge, park bushes along the Gorge pushed into service by illegal tenters.
But we don’t have to accept that. Housing people is not beyond our capability. We can choose to act.
Money will have to be spent, yes, but certainly no more than what it’s costing us in health care, lost earning potential, policing, and revolving-door court appearances for B.C.’s struggling underclass. That’s not even counting the economic impact on our downtowns of continuing to do nothing. Or the inevitable rise in communicable disease, crime and conflict.
That we’ve stayed this course for more than a decade is discouraging enough, but carrying on any longer can only lead to ever-darker places. The scenes that we’re seeing daily on our downtown streets would have been unthinkable 10 years ago. How far are we willing to go?
It’s about housing. It’s about doing what needs to be done to help people, whatever their challenges. It’s about income assistance, which has become a punishing and desperately mingy program that those with the most barriers can’t even access. If the people living on our streets are even on income assistance - and a whole lot aren’t - they’re expected to get by on as little as $180 a month. Nobody could do that, least of all somebody with a brain injury, drug addiction, untreated mental illness or otherwise massive problem.
It’s not about feeling sorry for people like that, although a little empathy wouldn’t hurt. It’s more about seeing where erroneous social policy has taken us, and taking action. We need to build housing, provide subsidies, look for innovative concepts. We need to acknowledge addiction. Families need to be supported and kids need to grow up with a community around them.
The hard-liners will tell you that nobody was around to mollycoddle them when they were learning to make their own way in the world. They prefer the “tough love” solution, which appears to boil down to cutting services in hopes that those who can’t live without them either die off quickly or move along. But so much has changed in B.C. in the last 30 years that there’s simply no comparing then and now.
The economy. Family structure. Our towns. Our connection to community. Everything’s different. The structures that prevented homelessness in years gone by have collapsed, exacerbated by relentless cuts to social services.
Cause and effect. In the end, it’s as simple as that.
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